A year in review

This is the third year I’ve written this blog. As the year ends, numerous people will be reviewing the year, reflecting on the good, the bad and the indifferent, and like them, I will too.

What has been the same this year is the endless need to repeat to all and sundry the following:

All chronic pain starts with acute pain – maybe if we were able to effectively manage risk factors for developing chronic pain in people when they first present for help with their pain, my job would be less in demand.

All pain, whether acute or chronic, is a psychological experience – and can’t be understood without an appreciation of the biopsychosocial model.

Because pain is a psychological experience means that we can’t divide pain into nociception and the psychological response to that nociception – because the two are indivisible. Our brains are not just ‘waiting for’ peripheral events to reach them – the brain is not a blank slate, it’s actively involved in determining which aspects of our experience ‘we’ will experience.

There is not a lot new under the sun in pain management really. Not a lot of new drugs (mostly they’re derivatives of opium, or they’re old drugs that have been adopted for new uses), and not a lot of new procedures, and no, not even a lot of new psychosocial/nonpharmacological treatments. With, perhaps, the exception of brain retraining a la Moseley, and the introduction of acceptance and mindfulness based treatments.

What has been different this year?

More discussion across ‘Web 2.0’, or the medium of the internet – Facebook, Twitter, blogging and email.

More detail of the aspects of the cognitive behavioural approach to pain management that is influential to change, and along with that, more recognition that one size does not fit all.

More detail of what works for whom and when.

More need to not only assess – but also treat people!

More recognition that people with pain live in a network of relationships with other people, within communities and sociopolitical systems including legislation, and that all of these have an influence on the person’s ability to cope.

Increasing recognition that the health provider relationship has as much influence on the individual as his or her own beliefs. Yes folks, what we say and how we say it does have an effect! Maybe not quite what we had expected, but definitely we have an effect.

More awareness that it’s not so much WHO delivers self management, but that self management IS delivered that is important!

In Christchurch, we’ve had the momentous earthquake and the aftermath. Internationally we have had wars, rumours of wars, pestilence and plague – and yes we’ve even had locusts (in parts of Australia!). Once again I’ve made friends with people from all around the world, all sorts of professional backgrounds, all sorts of interests in pain and pain management. And I’ve continued to learn – from fellow clinicians, colleagues, patients, the journals I’ve read, the blogs I’ve read, the discussions (and maybe even arguments!) I’ve had – all have prompted me to think and learn and question.

And once again, I reflect on the incredible nature of science and the way in which I, as a clinician, ‘stand on the shoulders of giants’ to learn more. To know that no ‘fact’ is sacred – that if there is evidence there to challenge a ‘received’ view, even a view that I’ve cherished, then it’s my duty to look at that evidence in the face and check it out. There is no need to resort to mysticism, nor to hold to magical beliefs, or sacred texts. Research is there for us all to learn from, and it’s my privilege to help share it to people who may not have the time or access to the information I do, and by doing this I might have a chance to help people live lives that are a bit better in quality than if I had written nothing. At least that’s what I hope happens!

I’m incredibly thankful to the people who take time to comment and question me. I’m not a guru, I’m definitely blinkered in my own perception of what I see, and I admit to being somewhat biased. That’s another reason for writing – by putting my thoughts out to the interweb, hopefully people can bounce ideas off what I write – and then ask me questions! And in doing that, I learn too.

2011. Who knows what it will bring. I expect (and yes, hope) it will bring even more questions! Do ya feel like coming along for the ride?!

I’ll be there!
Thank you for all you do to continue to help untangle the treatment of chronic pain, and to help us help ourselves.
I have definitely been inspired by you, and as a consequence of your writing, and my determination, am off oxycontin and I am working out 6 days a week, even if I am in pain. I am also working with a physical therapist who specializes in sports medicine, and I can honestly say my abs look better at 49 than they did at 19. Of course, that has helped with my back pain, so it keeps me working at it.
So, my hat is off to you, and I look forward to being there with you next year.

Great article! Author, who and where are you, please? It’s not clear to me from this blog.
Might you or someone aboard cite some of the most important pain treatment research pieces of the year?
For me, the study in Sept. “Neurology” showing that mindfulness helped with M.S. patients in Norway is one that comes to mind.
Best, Charles Horowitz, Ph.D.

Hi Charles
If you go to my ‘About’ page (it’s one of the tabs on the top of the front page of the blog) you’ll find out all about me. I’m not a well-known researcher, but am a clinician, educator and avid reader of all things to do with pain and pain management. I live and work in Christchurch, New Zealand, and have been working in pain management since … late 1980’s I think.
My background is occupational therapy, with a hefty dose of psychology (they warped me!) and I’m working on my PhD looking at the coping strategies that resilient people with chronic pain use to live well. Feel free to drop me a line via the ‘About’ page – it goes straight to my inbox.
Good idea – I’ll do a post on my personal favourite articles of the year, and I’m pretty sure at least one will be about mindfulness. Keep watching!

Bless you wonderful people! This is one of the main reasons I keep doing this (apart from having nothing to do between 6.00am when Manly Jack gets up and 7.30am when I need to get up and about!) – it’s the people that keep dropping in and let me know when I’m on the right track, and when I’m not, and tell me what is working – or not – and generally get all excited about the same stuff as I do! What an amazing thing this internet is!
Thanks to all of you for your encouragement and questions, and that inspiration that is so encouraging.
hugs
Bronnie